Adderall

Adderall 25 mg XR Capsules

Adderall® is a pharmaceutical stimulant amphetamine used to treat attention-deficit disorder/attention-deficit hyperactivity disorder and narcolepsy. Severe cases of depression may also be treated with Adderall or other stimulants. It was first prescribed in the 1920s as an anorectic (under the brand name Obetrol®), but such usage is now rare. Adderall is a schedule II controlled substance, meaning it has been deemed to have a high potential for abuse.

Use

Adderall was introduced in 1996 as instant-release tablets, which has since become available as the generic formulation "mixed amphetamine salts." The active ingredients of Adderall include a combination of dextroamphetamine and racemic amphetamine salts. Shire later introduced a gradual-release preparation of these ingredients, Adderall XR (extended release), and retains patent rights on Adderall XR that will expire in 2009.

In particular, Adderall XR is comprised of the following proportions of active ingredients:

• 1/4 Dextroamphetamine Saccharate
• 1/4 Dextroamphetamine Sulfate
• 1/4 dl-amphetamine Aspartate (racemic amphetamine)
• 1/4 dl-amphetamine Sulfate (racemic amphetamine)

The four component salts are claimed to be metabolized at different rates, thereby imparting a more gradual and "smoother" build-up and decline in effect compared to amphetamine preparations comprising only a single salt.

The average elimination half-life for dextroamphetamine is 10 hours in adults, and for levoamphetamine, 13 hours. Its effects are otherwise similar to other central nervous system stimulants (see amphetamine for details.).

The manufacturer claims that the mixture of salts makes Adderall's effects smoother, with softer highs and lows, than those of other treatments for the same disorders.

There is little evidence, however, to support this claim for immediate-release. A recent patent application for Adderall was a pharmaceutical composition patent listing a rapid immediate release oral dosage form. No claim of increased or smooth drug delivery was made. A recent double-blind, placebo-controlled crossover study, conducted among children, indicated that patients behaved similarly to other immediate release amphetamines. The authors found that sustained-release dexamphetamine (the main isomeric-amphetamine component of Adderall) had a longer duration of action, and cost less than Adderall, though dexamphetamine was less effective in the first few hours.

Adderall is now sold in either an immediate-release tablet or an extended-release capsule, marketed as Adderall XR (for "eXtended Release"). Doses for both immediate-release and extended-release form come in 5, 10, 15, 20, 25 and 30 mg increments.

Adderall XR utilizes the Microtrol® delivery system to achieve the extended-release mechanism. This delivery system incorporates two beads: the first type of bead dissolves immediately and the second type releases four hours later. Maximum plasma concentration is achieved in seven hours, compared to regular Adderall IR (immediate-release) which reaches maximum plasma concentration within three hours. As a result of its high bioavailability, Adderall XR's effectiveness is not altered by food absorption in the gastrointestinal tract. However, tmax (mean plasma concentration) is prolonged by 2.5 hours (using a standard high-fat meal as the control). Acidic beverages should not be ingested with Adderall XR as they alter the pH balance of the stomach.

Effects

While the exact mechanism is unknown, it is believed that Adderall works by blocking the reuptake of dopamine and norepinephrine into the presynaptic neuron and increasing their release from the presynaptic neuron into the extraneuronal space. In other words, Adderall reverses the reuptake mechanism, turning it into a pump instead of a vacuum. Sources note that amphetamine and related compounds (ephedrine, etc.) displace noradrenaline from the presynaptic neuron and do not act as reuptake inhibitors as referenced above.

The increased flow of dopamine and norepinephrine into the extraneuronal space causes the patients' brain, as one psychiatrist explains, to experience a more intense level of concentration, causing an increased ability to focus for extended periods of time, and a heightened interest in performing focus based tasks.

Double-blind, placebo-controlled studies of dextroamphetamine in normal subjects have shown significant performance increases on cognitive tasks and decreased reaction time.

Amphetamines have been shown to pass through into breast milk. Because of this, mothers taking medications containing amphetamines are advised to avoid nursing during their course of treatment.

Side effects

Aggression, new abnormal thoughts/behaviors, mania, growth suppression, worsening of motion or verbal tics and Tourette’s syndrome have been associated with use of drugs of this type.

Side effects in children

• decreased appetite
• difficulty falling asleep
• stomachache
• emotional lability

Side effects in adolescents

• loss of appetite
• difficulty falling asleep
• stomachache
• weight loss
• impaired growth

Side effects in adults

• dry mouth
• loss of appetite
• difficulty falling asleep
• headache
• weight loss

Other side effects

These less common side effects may occur at any age when used as prescribed.

• upset stomach
• nervousness
• mydriasis (excessive dilation of the pupil
• bruxism (teeth grinding)
• urinary retention
• pyrexia (fever)
• tachycardia (rapid heartbeat)
• tics
• urticaria (hives)
• erectile dysfunction
• increased urination
• blunted affect (emotional numbness).

Rare side effects

These symptoms require immediate medical assistance:

• hair loss
• tourettism
• aggressive behavior or hostility
• depression or bipolar disorder
• amphetamine psychosis, including abnormal thoughts or visions and hearing abnormal sounds
• seizures or abnormal EEGs
• high blood pressure
• cardiomyopathy
• sudden death

Dependence and addiction caused by abusing Adderall

Adderall's manufacturer lists the warning for drug abuse and dependence in the prescribing information for the drug. "Amphetamines have been extensively abused. Tolerance, extreme psychological dependence, and severe social disability have occurred."

If the patient has used Adderall for an extended period of time, and then suddenly stops taking it, withdrawal symptoms are likely occur that include extreme fatigue, mental depression, and sleeping problems. The severity of withdrawal symptoms increase with higher doses.

Contraindications

Using any amphetamine, (including Adderall, methamphetamine or MDMA) within 1-2 weeks of taking a monoamine oxidase inhibitor (MAOI) can cause a potentially fatal condition known as serotonin syndrome.

Performance-enhancing use

Because Adderall uses amphetamine stimulants to help the user concentrate for extended periods of time, many students today request Adderall from doctors in order to use it as a study aid. Thus, it is increasingly popular on college campuses. The largest benefit to students, however, is Adderall's ability to give students the power to focus on and learn what would usually be uninteresting material. Because of the appetite-suppressing properties of amphetamines, it is also sought after by those wishing to lose weight. Another less common use for students is to take Adderall before or during a night of heavy drinking in order to remain alert and active despite being intoxicated.

Research done by the National Institute of Drug Abuse (NIDA) shows the more competitive the college, the higher the incidence of stimulant use. An article published stated the findings of a nationwide survey of thousands of college students. The findings of this past April 2006 survey shows 5.9% use rates among the more competitive campuses, compared to 1.3% use rates among less competitive campuses. Breaking down the use pattern even further, this same sample done by NIDA reveals whites were more likely to use stimulants compared to African Americans and Asians, at rates of 4.9%, 1.6%, and 1.3% respectively. Further, students with lower grade point averages of B’s or below use stimulants at a rate of 5.2%, compared to students earning B+ or above who use this medication at rates of only 3.3%. This research also specifically identified that students involved in sororities or fraternities use stimulants at a much higher rate of 8.6% compared to nonmembers who reported use at rates of only 3.3%.

Another major concern about the use of Adderall among college students is the psychological dependence that may cause students to lose faith in their own ability to perform well and the dependence on the advantageous effects of stimulant medication. Jackie Kurta, an Alcohol and Drug Specialist at UC Santa Barbara’s Student Heath Services states, “Students start out taking study drugs one time to study. The drugs work so well that the students begin to lose confidence in their own abilities to study without them,” (Hirschey).

The black market price of Adderall varies widely, and is often between $1.50 to $10 per pill (size also varies from 5 to 30mg.) In some cases, pills may sell for as little as $.20 or as much as $25.

Aside from being used by college students as a study aid, Adderall has been used as an off label drug for weight loss. Adderall’s side effect of weight loss and appetite suppression is a desired result for those trying to lose weight. It is administered as part of a “cocktail” of other off label prescription drugs that have side effects used to treat obesity. There have not been any scientific studies performed to evaluate the effectiveness of this form of treatment and is viewed a very risky and potentially dangerous way to shed pounds.

Government warnings

On February 9, 2005, Health Canada suspended all sales of Adderall XR after data collected by manufacturer Shire Pharmaceuticals linked the drug to 12 sudden deaths in American children between the years 1999 to 2003. Further research, however, found little data suggesting use of Adderall resulted in an increased risk of cardiac defect. Of the twelve sudden deaths positively linked to pediatric Adderall users during the four year period, five had known pre-existing cardiac conditions, one died after strenuous exercise in 110 degree heat and two had levels suggestive of an overdose. Given the more than 37,000,000 prescriptions for Adderall filled during the four years, the US Food and Drug Administration could find no increased risk of sudden death among Adderall users beyond the normal rate of the general population. In August, 2005, Health Canada followed the committee report of three independent physicians and lifted the ban on Adderall XR. Given that persons with AD/HD are a high risk group, it has been suggested that stimulant medications for persons with AD/HD will actually result in lower incidence of premature death. advise against the use of Adderall in those persons with pre-existing cardiac or mental illnesses. They also suggest against its use in persons who have a history of drug abuse. Although FDA safety advisors voted 8 to 7 to issue a Black Box Warning, the FDA's pediatric advisory committee refused to give the drug its most severe black box warning in March, 2006. A Black Box Warning regarding amphetamine abuse potential is in place, however.

Manufacturers

Adderall is manufactured by Shire Pharmaceuticals and is distributed by Catalytica Pharmaceuticals Inc. of Greenville, North Carolina. Generic equivalents (known to pharmacists as "amphetamine salts," "mixed amphetamines," or simply "amphetamines," among other things) are also distributed in the United States by Barr Pharmaceuticals, Mallinckrodt Pharmaceuticals, Eon Labs and Ranbaxy Laboratories.

Theories for Increasing Effectiveness

The following is not supported by any scientific studies, but based purely on experimentation. Many people who use adderall in a less then legitimate manner look for ways to increase its potency. Based on other people's experience, I am providing some suggestions that have worked for them.

Smoking: smoking will increase your levels of nicotine, which will work on nicotinic receptors in the body. Nicotine will mimic the effects of Ach on nicotinic receptors. This is important with regards to adderall because of its involvement in the synthesis of epinephrine. Epinephrine is one of the transmitters adderall effects (prevents reuptake and stimulates release). Nicotine should help stimulate more epinephrine production and therefore increase its levels in the blood with the use of adderall.

Tums: Tums provides a nice source of Calcium. Calcium plays a very important role in the release of transmitters. Ca is required for exocytosis. Since adderall effects the release of various transmitters, it would seem reasonable that one would want enough Ca to maximize the excocytosing power. Tums also settles the stomach which adderall has been known to upset.

Caffeine: It’s a stimulant in its own right. Might as well take it. Nodoze provides a nice 200mg kick.

Food: stay away from fatty foods. Salts (amphetamines) don't play well with fats.

This information has been provided by ShareNotes College Lecture Notes

See also

• amphetamine
• methamphetamine
• methylphenidate
• dextroamphetamine
• HT-0712

External links

• Hanna, Mohab "Making the Connection: A Parent's Guide to Medication in AD/HD" Ladner-Drysdale 2006
• General Amphetamine Information

• Report of study indicating Adderall more effective than Ritalin for ADHD treatment
• Article by a medical doctor outlining the benefits of Adderall as an ADHD medication
• Adderall Abuse
• Adderall a crutch for students pressed for study time
• Adderall XR® barred in Canada

• The Adderall Me - My romance with ADHD meds by Joshua Foer in Slate
• Effects of Adderall